October 7, 2003

     Nowadays, whenever I enter a patient's room, I noticed that often their first question is "What kind of doctor are you?" Of course, in a split second, I would muse and consider if what they actually meant was "Are you a doctor?" then brace myself for what query might come next like "What the hell do you want?" Well, I'd comfort myself that it would not be the first time I'd be rejected on the spot: because a) the patient is mentally impaired, b) disappointed with his medical care, c) or purely by my skin color and being relatively young.

     Nevertheless, I felt tempted to respond by plagiarizing two responses I heard others say: "A good one" and "A handsome one", but then it may be inappropriate and the second answer seemed blatantly libelous. But, it must be admitted, a couple of times during an upbeat mood swing, I exclaimed the first statement and luckily, instantly earned good rapport. Then the split second ends and I must reply, assuming that it is my specialty the patient is referring to. Therefore, an apt reply would follow.

"...for residency applicants, it is imperative to really know what you want and what kind of life and earning you expect (both during and after residency). The cliché question always asked during interviews for a training program is still actually extremely important."

     The question is legitimate of course, now that medicine has been teased out into a myriad of specialties. Some opt to narrow down their field of expertise while some prefer to expand it. Naturally, there are advantages and disadvantages to both. The specialist gets to concentrate on a specific area and need only to deal with problems relevant to him. He has the option of getting off the hook and to refer to others if situations stray out of bounds. However, when there is competition, the going gets tough especially if the competitors are "liked" more by the medical "in crowd". Also, there is greater need to dig deep into the knowledge base and be updated; otherwise, you lose competency in your specialty and newer consultants will quickly leave you behind.

     Being not a specialist, i.e., being a general practitioner, opens up larger pastures. The training is shorter and the patient base is much larger. In an era of poor compensation from institutionalized payers, volume makes a huge difference. You still need continuing medical education but not as in-depth as the specialist. However, because there is a need to address multiple areas in a patient's medical care, there is also a need to be quite knowledgeable in a wide range of areas. Patient fees are also lower, but volume may compensate if you are willing to get really busy. You still need the "in crowd" to know which specialist to send your patients to.

     So, what determines which specialty you choose? Whim? Money? Training duration? Prestige? Lifestyle? Convenience? The consultant is your crush?

     A lot. Life is complicated. But let's break it down a little bit like what some researchers did in a study published in JAMA last September 3 (www.jama.com). Data from three matching programs was utilized to determine if a "controllable lifestyle" influenced medical students' decision on which specialty to choose. A controllable lifestyle was defined as personal time free of the practice (for leisure, family and avocational activities) and inversely proportional to the length of time working and being on night call. The specialties that were considered as having an "uncontrollable lifestyle" were: Family practice, Internal Medicine, OB/GYN, Orthopedics, Pediatrics, General Surgery and Urology. The reason for being not controllable was that practice is often busy, there are frequent night calls, many pages are expected after hours, and there is high likelihood of returning to the hospital at night.

     To make a long story short, it was found that 55% of medical students chose their specialty because of a controllable lifestyle, while income by itself was the factor in only 9%. Possibly because they wanted a good lifestyle and some acceptable income, more subjects chose a longer than average work hours and up to 4 years of training to achieve this goal. These results were reflected in recent residency program matches: there was a large decline in General Surgery and Family Residency positions filled.

     The bottom line is, for residency applicants, it is imperative to really know what you want and what kind of life and earning you expect (both during and after residency). The cliché question always asked during interviews for a training program is still actually extremely important.

     So please, know what kind of doctor you really want to be. And try not to suck at it.

     Why, isn't a being a doctor enough by itself? Sure it is, for some. A recent Gallup poll assessed which professions are rated by people to be "high" or "very high" in honesty and ethical standards. This was the result:

     Yeah, these are U.S. statistics; otherwise I would not have expected military and police officers up there (because of rampant corruption) and the clergy to be lower (after a string of pedophilia cases among priests which they finally uncovered only recently here). But hey, even though they love nurses, pharmacists, officers and even teachers more than doctors, at least, we still have 63% and probably earn more than they do. Well, I guess I love nurses the most too, ahem, especially one.

     What about lawyers and politicians???

     Back to the question of what kind of doctor you are. If you are good, it is definitely important; and if you are handsome (or pretty), it is definitely a plus. Most patients tend to see a doctor of their own gender research has shown. The latter quality may sway more business in your way. But take care because that "physician-patient relationship" has clear limits. But if a patient of the opposite sex comes by to see you, also remember that male and female patients tend to communicate differently. Just like in personal relations: we need to be aware of these differences so we can get an accurate history and give the correct information or instruction. A report by the Bradford Group summarized these differences.

• Female patients speak more, especially to female physicians while men speak less, especially to male doctors. I guess women talk more in general and would tend to bond more to their fellow females, while we men will rather not talk to each other except over a case of beer. And, only about our exploits to brag about, not our ailments. So we have to set limits for the chat and dig deeper if there is not enough.
• Females ask more questions and men would probably not. Reminds me of what to expect if you come home late, but that would apply to both. Anyway, brace yourself for her questions and not be annoyed; if the questions are dumb, it's because they are not physicians like you. If the guy is mum about his problem, you know that he's just being a man about it. Silent water runs deep. Try to loosen him up and give the needed information he needs even if the questions are unspoken.
• Females are more assertive and provide more information while men barely provide any and are more passive. I wish this were true elsewhere, other than the examination room, ahem. Women would more likely press you till she gets answers and would tell you about all the details even if not asked. Men would usually only tell you a telegraphic history and answer in one word sentences unless you ask open ended questions or he is really bothered about something.
• Female patients are more likely to smile and be pleasant, engage in direct eye contact and sit in a direct front closed posture. And men more often are stoic, look down or away and slouch. Hey, it's just being a guy. So respect the allowable distance and attitude with females to avoid sexual harassment complaints and break the ice for the guy to start engaging you.

     Men's ways are so different from women's ways that sometimes my better half tells me that men are a different species altogether. Especially in an argument, it may mean a lower species. Oh well. It is no justification, but look at Kris and Joey. See the huge differences in their bad habits, their expressions and the way they handled the crisis?

     So, again, what kind of doctor are ya?

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